Accelerating Progress towards Measles and Rubella Elimination, June 2016, Hotel Royal, Geneva National Center for Immunization & Respiratory Diseases Division of Viral Diseases Joseph P. Icenogle, the CDC rubella Team CDC colleagues, and collaborators MMRHLB primary contributors Adaeze Ogee-Nwankwo Diane Waku Global Health Security Agenda (GHSA) In the CDC Measles Mumps Rubella And Herpesviruses Laboratory Branch

PROBLEM DISEASES SPREADNOT PREPAREDECONOMIC IMPACT Faster and fartherAt least 70% of countries not prepared SARS: $40B Globally Ebola: >$30B Globally Why Care About Global Health Security

The Global Health Security Agenda A unifying framework to improve our global response to disease outbreaks

11 Action Packages AMRZoonoticsBiosafety/BiosecurityImmunizations LaboratorySurveillanceReportingWorkforce EOCsPublic Health & LawMCM & PD The US CDC GSL is involved in the implementation of these two packages in Ghana and Bangladesh Prevent Detect Respond

Ghana: Protecting Lives in the 2nd Year of Life (2YL)  Aim: Prevent morbidity and mortality from vaccine preventable diseases (VPD) by strengthening the second year of life (2YL) immunization platform  5 strategic areas  Training & Supervision  Data Recording and Reporting  Social Mobilization & Demand  Program Integration  VPD Surveillance  Special Innovations

Strategic Area 5: VPD Surveillance  Objectives (MMRHLB)  Strengthen measles and rubella surveillance including laboratory capacity in Ghana to allow rapid response to outbreaks and identification of areas of inadequate vaccine delivery or uptake  Support activities related to implementation of CRS surveillance  Strategy  Activities for 2016 Assessment of the National Public Health Reference Laboratory using standardized laboratory assessment tools. Gap analyses Remote assistance and funding for procurement of laboratory reagents and equipment Laboratory training workshop for measles and rubella detection and genotyping Follow up visit to assess progress, sustainability and discuss next steps  Activities continue through 2019

Assessment of the Ghana National Public Health Reference Laboratory (NPHRL)  Team of 2 MMRHLB staff visited NPHRL in Mar 2016  Objectives  Meet laboratory staff and key stakeholders, and tour the NPHRL  Complete two laboratory assessment tools: 1.the International Measles and Rubella Laboratory Capacity Review Tool 2.the WHO Laboratory Assessment Tool  Provide a report describing the status of laboratory capacity with recommendations for improvement based on data collected using both tools and observation of laboratory practices  Determine equipment and training needs for measles and rubella molecular testing

Tools  Tool 1: WHO Laboratory Assessment Tool - Facility Questionnaire  Eleven modules 1.Organization and management 2.Documents 3.Specimen collection, handling and transport 4.Data and information management 5.Consumables and reagents 6.Equipment 7.Laboratory testing performance 8.Facilities 9.Human resources 10.Biorisk management 11.Public health functions  Gap analysis  Summary

Tools  Tool 2: CDC International Measles and Rubella Laboratory Capacity Review Tool  Nine modules 1.Laboratory Contact Information 2.General Laboratory 3.Specimen Handling, Collection and Reporting 4.Virology Laboratory 5.Molecular Biology Laboratory 6.Laboratory Safety and Biosafety 7.Quality Assurance / Quality Control 8.Equipment 9.Training  Report template

Indicators WHO Laboratory Assessment Tool - Facility Questionnaire Summary Key: Red: < 50%, requires significant improvement Yellow: %, some improvement is necessary Green: > 80%, the laboratory is in good standing

Gap Analysis Key: 0 (no gaps) to 5 (high gaps) WHO Laboratory Assessment Tool - Facility Questionnaire Summary

Activities  Procure and install equipment for molecular biology  Ongoing  Provide reagent and supplies  Ongoing  Train NPHRL staff on molecular techniques for measles and rubella  Planned for 4 th quarter 2016

Linkage to CDC-supported projects in Ghana  GHS-activities can complement/be complemented by  Implementation of CRS surveillance (CGH/GID, GAVI-funded)  Identify challenges in rubella and CRS activities within the WHO-Global Measles and Rubella Laboratory Network (DVD/GID)  Laboratory capacity building for meningitis surveillance (GID/DBD)

Bangladesh GHS support  Phase I GHS country  Aim (MMRHLB): Strengthen surveillance for measles, rubella and CRS  Objectives:  Discuss challenges for surveillance of measles, rubella and CRS, and determine what areas CDC, in connection with GHSA, can provide support  Review case classification scheme for CRS

Bangladesh GHS support  Meetings with leadership and key personnel of various institutions:  CDC Bangladesh  National Polio, Measles & AMES Laboratory (NPML)  Expanded Program on Immunization (EPI)  WHO Bangladesh  Institute of Epidemiology, Disease Control and Research (IEDCR)  International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)  Laboratory tours

Future plans  Engage the leadership of IPH (parent institution of NPML) and advocate for routine measles and rubella molecular testing, and for supportive supervision of NPML  Strengthen lab capacity to detect measles and rubella to improve laboratory support for case-based surveillance and outbreak investigations  Conduct a comprehensive baseline assessment of NPML  Facilitate a training workshop on measles and rubella virus culture, isolation, serology and molecular techniques (coordinate with SEARO regional laboratory coordinator and RRL (Thailand NIH))  Procure reagents and additional equipment to perform lab tests  Establish measles and rubella molecular EQA  Conduct a follow-up visit to provide support and supervision, and monitor progress

Future plans, continued  Enhance surveillance for CRS and facilitate implementation of the WHO-SEAR regional surveillance protocol  Conduct a joint CDC/MoH/WHO-SEARO/WHO-Bangladesh evaluation of the current CRS surveillance system at the EPI program  Facilitate a training workshop on CRS epidemiology and surveillance for staff from all surveillance sites  Conduct a follow-up visit to the EPI program to provide support and supervision for CRS surveillance

Recommendation  LabNet should continue to seek to identify overlapping objectives with GHSA and work to engage in shared activities, even when different time lines, previous funding decisions, etc. present challenges.  Discussion to follow

National Center for Immunization & Respiratory Diseases Measles, Mumps, Rubella and Herpesvirus Laboratory Branch Acknowledgements The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. CDC MMRHLB Paul Rota Adaeze Ogee-Nwankwo Diane Waku Emily Abernathy Bettina Bankamp Raydel Anderson DVD/OD Arunmozhi (Arun) Balajee Lia Haynes GID Mawuli Nyaku Ghana 2YL team GMRLN Ghana NPHRL David Opare Gifty Boateng David B Nartey Eric Aborgah Michael Adzgble Bangladesh CDC Bangladesh Kevin Russel Kathrine Strum-Ramirez Erin Kennedy WHO Bangladesh Jayantha Liyanage Stephen, Chacko Bangladesh MoH Khondoker Mahbuba Jamil (NPML) Tajul Islam Abdul Bari (EPI)

Accelerating Progress towards Measles and Rubella Elimination, June 2016, Hotel Royal, Geneva National Center for Immunization & Respiratory Diseases Division of Viral Diseases Global Health Security Agenda (GHSA) In the CDC Measles Mumps Rubella And Herpesviruses Laboratory Branch